Surgical maneuvers for long-segment Hirschsprung pull-through in unique patients

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Medical Devices

Background:

• Hirschsprung disease involving the splenic flexure or proximal colon presents significant surgical challenges.
• Mobilizing the transverse colon for pull-through procedures can lead to distal ileum obstruction or insufficient length for pelvic anastomosis.

Purpose of the Study:

• To describe two surgical techniques, Deloyers and Turnbull, for facilitating transverse colon mobilization in Hirschsprung disease.
• To evaluate the outcomes of these techniques in patients requiring pull-through surgery.

Main Methods:

• Retrospective analysis of 13 patients operated on between April 2017 and April 2024.
• Detailed description of the Turnbull technique (mesenteric defect creation) and Deloyers technique (right colon rotation).
• Analysis of patient demographics, surgical history, technique used, complications, and follow-up outcomes.

Main Results:

• 13 patients (12 boys, 1 girl) were included, with a median pull-through age of 16 months.
• Turnbull technique used for middle transverse colon aganglionosis (4 patients); Deloyers technique for proximal transverse colon aganglionosis (9 patients).
• Median follow-up was 4.5 years, with one patient awaiting stoma takedown.

Conclusions:

• The Turnbull and Deloyers techniques are effective surgical options for Hirschsprung disease involving the transverse colon.
• These methods aid in mobilizing the transverse colon, potentially reducing complications associated with pull-through procedures.